My Cardiac Health Scare - A Silent Heart Attack?

Are you Morbidly Obese

I am Morbidly Obese, And I Know It!

So, I'm fat. I've been fat for several years. I know I am fat, and my friends and family know I am fat. I've been okay with being fat—until recently.

I started gaining weight many moons ago when I went to college. Like pretty much every other college student, I put on weight when I lived on my own and was responsible for myself for the first time in my life. I didn't eat as well as I should have, and I knew it.

The weight went on gradually over the years. It was insidious. When my first marriage broke up, my weight ballooned. The numbers on the scale had been creeping slowly upward before then, but the depression and stress of my broken marriage paralyzed me. However, I am not going to sit here and lie—I knew I was getting fat, I knew I was eating in unhealthy ways. I have never been under any illusion as to the cause of my morbid obesity. I am the sole cause. I blame no one else and nothing else; it was my doing. I didn't get fat because of McDonalds, I didn't get fat because of high fructose corn syrup. Sure, those things contributed, but in the end it was up to me.

I like food. I like food more than I probably should. I also eat too fast, and my portion sizes are out of control. I am not as active as I should be. These are the reasons I am fat. It is my lack of self-control and laziness. That is all.

Why do I confess this in public? Two reasons. One, to acknowledge to myself that I am to blame. The other is to motivate me to change. I need to change the way I eat, what I eat, and how I eat. In the end I know that this will have a bigger impact on my overall health than anything else.

Morbid obesity is a chronic condition. ... Morbid obesity is a medical term describing people who have a Body Mass Index (BMI) of 40, or of 35 to 40 with significant medical problems caused by or made worse by their weight. BMI of 40 amounts to approximately 100 pounds above ideal weight.

— https://www.oakwood.org/what-is-morbid-obesity

A heart with a white EKG peak superimposed | Source

Why I Need to Change

Often when people vow to make a major change to their lifestyle, such as I am making, people often want to know what the motivation to change was, the what made you realize you need to change moment. Well I've known I've needed to change for some time. I've even attempted it in the past. I have tried a number of diets over the years, some rather successful, some not so much, but in all cases I returned to my cavalier attitude towards my health in relatively short time.

The first time I realized that I need to pay more attention was mid way through first year college. I had gained a fair amount of weight, and I noticed it. I wasn't morbidly obese at this point, probably on the obese scale, but not to the point of morbidly obese. I vowed to change my ways. I got up an hour earlier ever day and went for a jog. I didn't really change any other habits, just increased my activity. This worked for me rather effectively. It increased my energy and I shed some of the excess pounds I had but on with too many beers, crap diet and all the other joys of college living. Once I was back down to a weight I was comfortable with I stopped running every morning.

Life went on and the cycle repeated. I would gain weight realize it, try one strategy or another, lose some weight (or not) and return to my old ways. I tried a number of fad diets, I dated (and eventually married, and then eventually divorced) a woman who also struggled with her weight and was a big fan of wacky diets like Atkins, and South Beach, and tomato soup diet, and juice cleanses, and so many more. I didn't try all of them, but I tried a number, and others I second hand dieted. That is my diet improved simply because the food in the house to snack on became healthier due to her diet restrictions, and the food we cooked for dinners also were healthier. I've never been a proponent of cooking multiple meals for one household, so I may have wanted a hamburger, but if what was made for dinner was plain pasta with veg and herbs, guess what I ate! So I'd lose some weight, become comfortable with this new weight and return to my old ways. And so life went on and the cycle repeated. Again, and again, and again, ad nauseam.

So, although there was no moment I can pinpoint as being THE moment I realized I needed to change, there was a single moment that shines in my mind as the terrifying moment I realized that this need to change was urgent and could no longer be just part of the never-ending cycle of yo-yoing my way to the grave.

This was the moment when my doctor came in and told me, "So, you've had a heart attack. You can go home now."

Between 1985 and 2011, the prevalence of adult obesity in Canada increased from 6.1% to 18.3%. Furthermore, since 1985, the prevalence of obesity in classes I, II and III increased from 5.1% to 13.1%, from 0.8% to 3.6%, and from 0.3% to 1.6%, respectively.

— http://cmajopen.ca/content/2/1/E18.full

Wait.... What?

Yup. My doctor, a medical professional who is paid to keep me as healthy as he can, told me cavalierly that I'd had a heart attack—and then sent me on my way. There was no further explanation, no details on what I should do going forward, nothing. This is why my wife always says, just because they graduated doesn't mean they graduated the top of their class. In other words, just because they have an MD doesn't mean they are smart. I am not saying my doctor is dumb, but he has certainly failed me in this rather critical time.

So, let me digress a bit and give you some background. You see, about two years prior to my doctor's terrifying comment, my wife was shoveling snow while I was inside on a recliner just breathing. While she was shoveling, she realized that every year since we moved into a place where we were responsible for shoveling snow (three years at this point), she had shoveled the snow, pretty much exclusively.

Now I want to be clear, I am not such a lazy oaf that I would intentionally allow my wife to be the sole shoveler of snow, especially not where we live (Northern Alberta), where it can get do -40° C. The fact is, every year I ended up getting a rather bad chest infection. This time I believe it was pneumonia, but often it would be bronchitis. We then talked about it and realized that for the past six or seven years I had been getting increasingly severe chest infections every single winter.

This realization sent me to the doctor to try to find out what was going on. He sent me to specialists and they poked, prodded, and ran all sorts of tests. I did a breathing test, and found that my asthma, which I thought was not bothering me since childhood, had reared its ugly head and was causing me more breathing troubles then I was acknowledging. I did a stress test, which told me I was terribly out of shape (and there was a more disturbing find which I will go into later). Finally I went to another specialist who diagnosed me with a deviated septum. It was rather severe I had only 20% air passage in one nostril and essentially 0% in the other. In short I could not physically breathe through my nose. Now you might ask yourself "how does one not notice they can't breathe?" It's simple really, all my life I had this deviated septum, I didn't know any better, for my entire life I've been breathing primarily through my mouth and I never thought anything of it. When I was part of my schools long distance running team (yes, that's right there was a time I was somewhat athletic) my coach tried to drill it in my head that if I practiced breathing in through my nose out through my mouth I'd be better at running (yes that's right, I may have been somewhat athletic, but I still sucked at it), but I could never get the hang of it, and I thought it was because I just wasn't good enough, or coordinated enough to pull it off.

My doctor puts my name in the list to get nose surgery to repair the deviation, and eight months later I am recovering with two pieces of plastic that are three sizes to large to have any business in any orifice shoved up my nose. When I get the plastic torture devices yanked out along with about 40 metric tonnes of mucous (and after a couple weeks recover from having said plastic knives and mucous unceremoniously ripped from my sinus cavity) I inhale through my nose for the first time post surgery and realize I can breathe.

In my post-op follow-up appointment my surgeon assures me that, in all likely hood, there is a good chance that I might not get as many chest infections as I have been getting. The theory was that the deviated septum was a big part of the issue, that I would get a minor sinus infection, and instead of the sinuses draining most of the crudge out my nose like a normal healthy person without an S shaped nose everything was draining down my throat and I was occasionally aspirating some of it and this would cause infection. And lo and behold that winter I got the flu, but no I did not end up with Bronchitis or Pneumonia, or any infection at all.

I was elated, and I even shoveled snow a couple of times. Then came spring. Now I should set the scene, I have been referring to the woman who resides with me as my wife, but at this point she was merely my fiance, slightly more than just "that chick I am currently shacked up with" but not quite my bride. At this point in time we are preparing for a wedding, a July wedding was the plan, and we were doing all the work ourselves, self catering and all. It was going to be crazy, but fun (spoiler alert, it was!) However I took that stress and decided my fiance could use just a tad more stress, a self catered wedding was not enough stress. I decided it was time to get ill, and I don't just get sick, I take it to a whole new level, cause that's how I roll.

I got sick and ended up with.... drum roll please..... a viral infection in my chest. Yup, that's right, just when I thought it was safe to breathe without coughing up a lung I go ahead and get so very ill I can barely stand on my own without hacking up a lung and damn near passing out. Eventually it gets bad enough I need to go to the doctor to get a note to excuse me from work until I recover, the doctor examines me writes me a note. While the doctor is out of the room a nurse asks "have you ever had a heart attack?" I answer that I certainly have not. She leaves and a few minutes later the doctor returns gives me the note which excuses me from work until further notice and says "So, it looks like you may have had a heart attack. See you next time" and walks out. I am left sitting there going, wait... A heart attack! Wait.... what???? But too little too late he was gone the appointment was over and I was left confused and scared.

A few days after this prodigious pronouncement I was at home trying to relax when my heart started beating hard and fast, racing, my chest started hurting, it kind of felt like heart burn, but not quite in the right spot (as a sufferer of acid reflux I am painfully aware of how and where heartburn tends to hit me) I began to feel a little dizzy and nauseous, my fingers started tingling like they were asleep. Over all I felt terrible. I told my wife and she said we should go to the hospital, I started to say no, but then I remembered the doctor telling me I had probably had a heart attack, and I caved immediately and we made our way to the Emergency Room of the local hospital.

I've been to the ER countless times, and I've seen wait times from days to seconds, only a handful of times have I witnessed someone being waved through triage straight to an examination room, this was one of those times. The nurse at triage asked what the problem was and I could not respond, but my wife simply said, heart attack symptoms and just like that I was in an examination room being treated. The nurse asked if I had had a heart attack in the past, and for the first time ever I had to answer with "I think I might have", or rather my wife answered this question for me. The nurses were a little confused that I didn't know for sure, but they rolled with it, especially since they saw my family doctor happened to be the doc on call that night. They paged him but began treating me under the assumption badness was occurring. They hooked me up to an EKG (or is it ECG, I can never remember) and started to watch my heart rate. My resting heart rate was a startling 120bpm and when I coughed or did any movements at all really it would quickly rise from there. It was a horrifying experience, and a humbling one as well. I went from being ill to my wife answering all my medical questions because I couldn't between the chest pains and the chest infection talking was just a difficulty that was out of my reach, not to mention being hooked up to all sorts of wonderful machines and having the heart rate monitor beep every few seconds warning me that my heart rate was too high. They gave me nitro and most of the symptoms receded, and my heart rate dropped to 110, still high, but not quite as scary.

The doctor finally showed up, examined me, and told me that no I was not currently having a heart attack, but it did seem like it was close. He then explained that the heart attack he was referring too at the last appointment was a year and a half ago. Back when I had the stress test it was found that I had, at some point, had a silent heart attack, probably caused by lack of oxygen from my chest infections. He told me there must have been some sort of miscommunication which is why I didn't know about it, and that someone should have told me, then he sent me home.

I made a follow up appointment when I got a little better, and the doctor really didn't seem to interested in following up on the heart attack news, just the current (and to my mind less important) chest infection. His only comment on the heart attack, despite my pressing for some advice, was that I had lost a little bit of weight and that was the only remedy he would put forward.

So here I was with the earth-shattering (to me at least) news that I'd had a heart attack, and my doctor was perfectly fine with my health. Sure, I had lost a bit of weight, but I had just had a rather serious chest infection that had kept me bed-ridden and eating next to nothing for three weeks. Of course I'd lost a bit of weight, but weight loss through illness was obviously not a viable strategy going forward.

So, I was left to my own devices to improve my health—or die of a heart attack sometime in the near future.

Heart and Stroke infograph | Source

Specimen showing myocardial infarction in the left ventricle and the interventricular septum. The asterisk(*) also indicates left ventricular hypertrophy. | Source

Have you had a heart attack?

So What Caused my Heart Attack?

I once again make the statement: I am morbidly obese, and I am well aware of this. Now when you are morbidly obese, everyone, including doctors, assume all other aspects of your health are deteriorating and that that deterioration is directly due to the obesity.

Now, I have not doubt at all that my obesity contributed to the heart attack; however, I do not think it is the cause. Lack of any useful medical assistance, advice, treatment or general follow up to the heart attack I don't know for sure, that being said I do have medical resources above and beyond our regular health care system. The wonderful woman I was set to make my wife is not only the most sexy and beautiful woman I know, she also happens to be rather intelligent. I don't mean this in the regular she-can-carry-on-an-intelligent-conversation-in-most-situations way. I mean as in, she is actually an honest-to-goodness trained microbiologist with experience in cardiac health. This fact has come in handy in the past when dealing with negligent doctors, but in this case it has helped me figure out that the most likely cause of my heart attack was: lack of oxygen.

My chronic chest infections caused me to have low oxygen in my blood, which caused my heart to work harder than it should have, which in turn caused a heart attack. Above and beyond the obvious reasons why this is the likely cause, there is also the fact that I don't have any of the other warning signs for heart attack. Sure, I am overweight (I think we may have already covered that), but my cholesterol has always been rock steady, my blood pressure pretty much perfect. In short there is no evidence of plaque build up in my arteries that normal cause the type of blockage that is the source of Coronary Thrombosis, the next logical explanation is a low oxygen scenario, and since we knew that between my deviated septum, asthma, and my chest infection I likely wasn't getting enough oxygen, it seems reasonable to assume that this is what caused my heart attack. The heart working harder to make sure the rest of my body stayed oxygenated most likely just overworked itself which led to a myocardial infarction or blood not flowing to part of the heart due to and causing damage to the heart muscle.

Why Didn't I Know I Had a Heart Attack?

Heart attacks are major events, your heart is physically damaged and permanently altered. The symptoms of heart attacks are well known to most people.

Chest pains

Soreness in the arms and/or back

Shortness of breath

Feelings of heart burn

Stomach Upset

Throat, neck, or jaw discomfort

Anxiety

The problem is this is the symptoms of most heart attacks. Some estimates claim as much as 80% of heart attacks are never diagnosed, a major cause of the lack of diagnosis of heart attacks are what are called silent heart attacks.

Silent heart attacks, which possibly account for up to 45% of heart attacks, have very few symptoms and are usually the symptoms that are experienced are minor enough that sufferers ignore the symptoms entirely. Often silent heart attacks happen in a sufferers sleep.

Was my heart attack silent? Yes, and possibly no. Yes, in that I did not realize I had a heart attack, and possibly no in that I can't say I didn't experience these symptoms, but if you look at the symptoms you'll see that most, if not all are the same symptoms you'd expect someone who was suffering from a chest infection to also be experiencing. So perhaps I felt the heart attack but assumed it was just my already debilitating illness, or perhaps it was a truly silent heart attack and I simply didn't experience the symptoms. Being as I wasn't told about the heart attack until a year and half after I was diagnosed with having had a heart attack, and even at that it was just a diagnosis of having had a heart attack at sometime in the past with zero timeline given, I have no reasonable way of knowing or even guessing what my symptoms at the time were.

In short I didn't know I had had a heart attack because I didn't recognize, or feel any symptoms, and my doctors did not notify me of the diagnosis.

So What Now?

So now I am left with a faulty ticker, and no medical advice. I was forced to come to the realization that my health is my own responsibility. Naturally I've always known this, but the realizing this in the face of heart issues it was time to take a much more active role. It was time to get in better shape, and I made a rather odd decision, I am NOT going to try to lose weight.

I know, this seems contradictory, but allow me to continue and you might agree that I have made the right decision. There is no trick here, I'm really not going to focus on losing weight. My focus instead will be on changing my eating habits, and increasing my activity. Exercising regularly and carefully monitoring everything I eat. This is my plan. Improve my overall health, and alter how I view food. Weight loss will most likely be a side effect of this plan, however it is not the goal.

Too this end I have a fitbit to help me track my activity, I use Losit.com to track my calories, and I got a treadmill so I can actually follow through with my plan. I have already increased my activity considerably. Prior to this I usually got 6,000 steps in per day, I am now doing 10,000-15,000 steps. I haven't lost a considerable amount of weight, but as I stated weight loss isn't the issue, overall health is. My resting heart rate has gone down considerably, and I am able to walk much further than I could before. I know and expect it to take time, a considerable amount of time. I am taking the slow and steady method to this, lifestyle changes, I am not expecting rapid changes. This over all change is not something I expect to put a timeline on, this is intended to be a permanent and ever changing change.

Goals

A huge part of the change I want to make in my life is setting achievable goals. These are the goals I've set for this year:

Short-term goals:

Walk or run a 10K race.There are several races in the area, and I intend to do at least one 10k race in the next 12 months.

Summit a mountain.Living in Alberta has many benefits, not least of which is the proximity of some of the most beautiful sites in world in the Rocky Mountains. Not too far from where I live is Grande Cache, Alberta, nestled in among the peaks of the mountains. There is a program in the area called Passport to the Peaks, My goal is to get at least one stamp in the passport. You earn stamps by hiking to the summit of one of many mountains in the area.